MEDICARE: DR. MATTHEW BRANDL ROSSI MD

Medicare Provider Information

Scope of Practice

The following information about the specialty of the provider is available:

#	Taxonomy Code	Taxonomy	License Number	License Number State
1	208D00000X	General Practice Physician	036082575	IL
2	208600000X	Surgery Physician	036082575	IL
3	2086S0129X	Vascular Surgery Physician	036082575	IL

Other Identifiers

#	Provider Identifier	Provider Identifier Type	Provider Identifier State	Provider Identifier Issuer
1	MEDICAID ID Found: Get Medicaid Details using Online Medicaid Verification Program

General Provider Information

NPI Number	:	1205874310
Entity Type Code	:	Individual
Provider Name (Legal Business Name)	:	DR. MATTHEW BRANDL ROSSI MD

Provider Business Mailing Address
First Line	:	PO BOX 267
Second Line	:	107 TREMONT ST
City	:	HOPEDALE
State	:	IL
Zip	:	61747-0267
Country	:	US
Telephone Number	:	309-449-4450
Fax Number	:	309-449-4488

Provider Business Practice Location Address
First Line	:	107 TREMONT ST
Second Line	:	MEDICAL ARTS PHYSICIANS
City	:	HOPEDALE
State	:	IL
Zip	:	61747-0267
Country	:	US
Telephone Number	:	309-449-4450
Fax Number	:	309-449-4488

Authorized Official
Title or Position	:
Name	:
Credential	:
Telephone Number	:

Provider Enumeration Date	:	06/02/2006
Last Update Date	:	03/25/2011

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